Role of Cardiovascular Magnetic Resonance in Cardiac Amyloidosis: A Narrative Review.

Amyloidosis is a rare infiltrative condition resulting from the extracellular accumulation of amyloid fibrils at the cardiac level. It can be an acquired condition or due to genetic mutations. With the progression of imaging technologies, a non-invasive diagnosis was proposed. In this study, we discuss the role of CMR in cardiac amyloidosis, focusing on the two most common subtypes (AL and ATTR), waiting for evidence-based guidelines to be published.

The Role of Coronary CT Angiography in the Evaluation of Dual Left Anterior Descending Artery Prevalence and Subtypes: A Retrospective Multicenter Study.

BACKGROUND: The aim of this multicenter study was to evaluate the prevalence and features of dual left anterior descending artery (LAD) subtypes using coronary CT angiography (CCTA). METHODS: A retrospective multicenter analysis of 2083 CCTA from December 2020 to November 2022 was conducted to search for the presence and morphological features of dual LAD. The two classifications used were the updated classification of Spindola-Franco and the Jariwala classification. Statistical tests were conducted to evaluate the prevalence of dual LADs among sexes and its association with angina in patients without significant coronary stenoses and/or associated cardiac anomalies. RESULTS: Dual LAD was observed in 124 (5.96%) patients analyzed. According to the Spindola-Franco revisited classification, type I dual LAD was the most common (71/124, 57.26%). According to the Jariwala classification, all cases were group I. In the general population, there was a higher prevalence of dual LAD among females (7.3% females vs. 5.1% males; p value: 0.04). No statistically significant difference was found in the prevalence of angina in the dual LAD population compared to the no dual LAD population (2.1% vs. 1.5%; p value: 0.10). CONCLUSIONS: The acknowledgment and reporting of LAD duplication is helpful for an optimal management of coronary patients with this condition. Dual LAD was more frequent in the female population, mainly not related with angina. Myocardial bridge was more frequent in the dual LAD population than in the no dual LAD population.

Active Breaks: A Pilot and Feasibility Study to Evaluate the Effectiveness of Physical Activity Levels in a School Based Intervention in an Italian Primary School.

Background: The school gives access to children, regardless of age, ethnicity, gender and socio-economic class and can be identified as the key environment in which to promote children's physical activity (PA). The guidelines of the European Union recommend accumulating at least 10-min bouts of PA to reach the daily 60 min. Active breaks (ABs) led by teachers inside the classroom represent a good strategy to promote PA. The aim of this pilot and feasibility study was to evaluate the feasibility and effectiveness in terms of PA level of an AB programme in children aged 8-9 years attending primary school. Methods: A pre-post quasi-experimental pilot and feasibility study was performed in two primary school classes, one of which was assigned to a 14-week AB intervention (AB group) and the other to the control group (CG). At baseline and at follow-up, children were monitored for sedentary and motor activity during an entire week using ActiGraph Accelerometer (ActiLife6 wGT3X-BT). The satisfaction of children and teachers was assessed by self-administered questionnaires. Results: In the pre-post comparison, AB group (n = 16) showed a reduction in the minutes spent in weekly sedentary activity (-168.7 min, p > 0.05), an increase in the number of step counts (+14,026.9, p < 0.05) and in time spent in moderate to vigorous PA (MVPA): weekly MVPA: +64.4 min, daily MVPA: +8.05 min, percentage of MVPA: +0.70%. On the contrary, CG showed a worsening in all variables. ANCOVA analysis, after adjusting for baseline values, showed significant differences between the AB group and CG for time spent in MVPA, percentage of MVPA and step counts. The satisfaction of children and teachers was good. Teachers were able to adapt the AB protocol to the needs of the school curriculum, thus confirming the feasibility of the AB programme. Conclusions: This pilot and feasibility study showed the feasibility and effectiveness of the AB protocol and represented the basis for a future controlled trial.

ATP bioluminescence assay for evaluating cleaning practices in operating theatres: applicability and limitations.

BACKGROUND: Environmental cleaning practice plays an important role in reducing microbial contamination in hospital surfaces and contributes to prevent Healthcare Associated Infections. Adenosine Triphosphate (ATP) bioluminescence assay is a commonly used method for assessing environmental cleanliness on healthcare surfaces. This study tested the feasibility of using ATP-bioluminescence assay for evaluating the efficiency of cleaning procedures in the operating theatre settings, comparing the ATP-bioluminescence test with the traditional culture method. METHODS: The surfaces of 10 operating rooms of two public hospitals (140 samples in total) were examined "at rest", in two moments of the same daily session: before the first scheduled operation (Pre), and before the second, after a clean environment was re-established (Post). Surface contamination was assessed using the cultural method to detect Total Viable Counts (TVC36°C) and ATP-bioluminescence assay (RLU). RESULTS: The examined surfaces presented very low TVCs (geometric means: 1.8 CFU/plate; IC95%: 1.6-2.0), always compliant with the relative reference standards. No statistical correlation was found between ATP values and TVCs. However, considering the results in terms of general evaluation of hygienic quality of surfaces, the two methods were consistent in identifying the most contaminated areas (Hospital A > Hospital B; Pre > Post; most contaminated surfaces: scialytic lamp). Furthermore, the ATP mean values showed a progressive increase from surfaces with TVC = 0 to surfaces with TVC > 15 CFU/plate. CONCLUSIONS: Although not an alternative to cultural methods, the ATP-bioluminescence-assay can be a useful tool to measure the efficiency of cleaning procedures also in environments with very low microbial counts. Each health facility should identify appropriate reference values, depending on the devices used and on the basis of the analysis of the data collected through spatial and temporal sampling series. By providing a rapid feedback, the ATP-assay helps to increase the awareness of operators and allows immediate action to be taken in critical situations.

[Urethral injuries secondary to implantation of penile prosthesis. Analysis of the causes, prevention and treatment]. / Lesioni uretrali da impianto di protesi peniena. Analisi delle cause, prevenzione e trattamento.

Urethral injuries due to penile prosthesis implant represent a rare complication of the intervention to position penile prosthesis, but unfortunately scientific literature about this is poor. This rare complication may occur during surgery and in the postoperative period, both early and late. It recognizes a variety of causes that may include anatomical or functional conditions, for example cavernosal fibrosis or outcomes of inflammations or previous urethral lesions and pathological sensibility due to diabetic neuropathy or other forms of neuropathy including those from spinal cord injury or myelopathy. This review evaluates the possible predisposing conditions, the clinical presentations, and the devices in the surgical procedures to use to minimize the risk of onset of this lesions and the measures to take if they occur.

Serum glutamate levels correlate with Gleason score and glutamate blockade decreases proliferation, migration, and invasion and induces apoptosis in prostate cancer cells.

PURPOSE: During glutaminolysis, glutamine is catabolized to glutamate and incorporated into citric acid cycle and lipogenesis. Serum glutamate levels were measured in patients with primary prostate cancer or metastatic castrate-resistant prostate cancer (mCRPCa) to establish clinical relevance. The effect of glutamate deprivation or blockade by metabotropic glutamate receptor 1 (GRM1) antagonists was investigated on prostate cancer cells' growth, migration, and invasion to establish biologic relevance. EXPERIMENTAL DESIGN: Serum glutamate levels were measured in normal men (n = 60) and patients with primary prostate cancer (n = 197) or mCRPCa (n = 109). GRM1 expression in prostatic tissues was examined using immunohistochemistry (IHC). Cell growth, migration, and invasion were determined using cell cytotoxicity and modified Boyden chamber assays, respectively. Apoptosis was detected using immunoblotting against cleaved caspases, PARP, and γ-H2AX. RESULTS: Univariate and multivariate analyses showed significantly higher serum glutamate levels in Gleason score ≥ 8 than in the Gleason score ≤ 7 and in African Americans than in the Caucasian Americans. African Americans with mCRPCa had significantly higher serum glutamate levels than those with primary prostate cancer or benign prostate. However, in Caucasian Americans, serum glutamate levels were similar in normal research subjects and patients with mCRPC. IHC showed weak or no expression of GRM1 in luminal acinar epithelial cells of normal or hyperplastic glands but high expression in primary or metastatic prostate cancer tissues. Glutamate deprivation or blockade decreased prostate cancer cells' proliferation, migration, and invasion and led to apoptotic cell death. CONCLUSIONS: Glutamate expression is mechanistically associated with and may provide a biomarker of prostate cancer aggressiveness.

Sinonasal hemangiopericytomas: clinicopathologic and imaging findings.

Hemangiopericytomas are rare soft-tissue neoplastic lesions that can arise in any part of the body. They are mesenchymal tumors that account for 3 to 5% of all soft-tissue sarcomas and 1% of all vascular tumors. They originate in extravascular cells (pericytes). Some 15 to 30% of all hemangiopericytomas occur in the head and neck; of these, approximately 5% occur in the sinonasal area. We describe our brief retrospective review of 7 histologically proven cases of sinonasal hemangiopericytoma, and we discuss the imaging characteristics and clinical and pathologic findings in these patients.

Punch biopsies of melanoma: a diagnostic peril.

Excisional or incisional biopsies of melanoma are used to determine depth of tumor invasion and to plan subsequent treatment. Accurate determination of depth of melanoma invasion is critical for treatment decisions and prognosis. Incisional or punch biopsies can be perilous for histopathologic determination of invasion, and both over- and underestimation of invasion can occur when using incisional methods. Likewise, histologic factors can lead to over- and underestimation of invasion. Prognosis and treatment of melanoma are primarily determined by depth of tumor invasion. We discuss several scenarios that can lead to over- and underestimation of depth of invasion in incisional biopsy specimens. We therefore discourage incisional or punch biopsies of suspected melanoma and recommend that depth of invasion not be reported on these types of specimens.

Renal cell carcinoma with peri-renal fat necrosis radiographically mimicking extra-capsular tumor extension.

Peri-renal fat necrosis is rarely encountered, especially in the absence of previous surgery, trauma, or pancreatic disease. We report a patient being followed for chronic renal insufficiency by renal ultrasound in whom a renal mass was detected. Imaging studies were suggestive of renal cell carcinoma with extra-capsular extension. Histologic study confirmed renal cell carcinoma but the radiographic impression of tumor extension into surrounding adipose tissue was explained by peri-renal fat necrosis and fibrosis. To the best of our knowledge, this is the second reported case of peri-renal fat necrosis associated with renal cell carcinoma. We propose a possible mechanism for the association.

Cost-effective method for identification of dimorphic fungi.

Traditional methods to identify dimorphic fungi dictate that the mold be converted to the yeast phase at 35 to 37 degrees C. We present a time- and cost-saving method of confirming the identification of a dimorph by using special stains to demonstrate the yeast phase directly growing in the original clinical specimens.

Collision tumor of apocrine carcinoma and squamous carcinoma occurring in the ear.

An unusual case of a cutaneous collision tumor comprised of a squamous cell carcinoma and an apocrine carcinoma occurring in the auricle of an 82-year-old man is presented. Microscopic study confirmed 2 distinct tumors: a squamous cell carcinoma arising in the epidermis and an adjacent apocrine carcinoma. We discuss the diagnostic criteria and review pertinent recent literature. To our knowledge, this is the first English language report of such a collision tumor.

Synchronous adrenal cortical carcinoma in a patient with lung cancer.

Workup of a patient with lung cancer involves adrenal imaging for evaluation of metastatic disease. When nodules are detected, biopsy is often attempted to differentiate a primary neoplasm from metastatic carcinoma or other lesions, such as granuloma. CT-guided biopsy of the deep seated adrenal glands is technically difficult and material is often scanty. We present a case and review histologic features enabling the diagnosis of adrenal cortical carcinoma.

Prostatic epithelial polyp diagnosed in a bladder wash.

Prostatic epithelial polyps, also known as adenomatous polyps or papillary adenomas with prostatic type epithelium, are uncommon lesions. These lesions typically involve the adult male urethra, trigone, or bladder dome. Diagnosis is usually made by biopsy. Presence of clusters of benign columnar cells in urine cytologic material can suggest the presence of such polyps and must be included in the differential diagnosis.